Tina, 19, woke up in a pool of blood with a suicide note next to her—and no memory at all of having written it during an alcoholic blackout.*

Liam, 18, who started drinking at 11, spurred both of his addicted parents to start their own recoveries when he descended into heroin addiction at 17.

And Stacy, 24, was already hospitalized for depression when she overdosed on pills while out on a day pass during her junior year of high school.

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All three are now either graduates of, or currently attending, recovery high schools—in their cases, public schools, with a varying mix of city, state, and private donations paying the bills. The schools aim to provide a supportive environment for adolescents with alcohol and other drug problems. They don’t admit students who don’t have a desire to stop drinking or using and the majority of students have completed at least one, often several, treatment programs.

Stacy, Tina, and Liam are all drug-free now. Tina is headed to Northeastern University in the fall, Stacy has been accepted into the Peace Corps, and Liam is starting a carpentry apprenticeship.

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Recovery schools seem committed to avoiding the mistakes often made in adolescent treatment—like “one size fits all” 12-step treatment, punitive and humiliating disciplinary practices, insistence on the acceptance of the “alcoholic” or “addict” label, and rapid expulsion for relapse. Some even take a harm reduction approach.

At least two dozen recovery high schools now operate across the U.S., with more planned, although budget cuts have forced some to close and threaten others. The first opened in the late ’70s and early ’80s, with current schools located in Massachusetts, Texas, Minnesota, California, Wyoming, and other states. Actress Kristen Johnston, best known for starring in 3rd Rock From the Sun, has been working for about five years to create New York City’s first sober high—she founded the non-profit organization SLAM (Sobriety, Learning and Motivation) in order to do this. However, it is not easy to start schools in the city’s complex and financially strapped educational bureaucracy.

But do recovery high schools really help? Or are they simply an extension of an often-dysfunctional treatment system, which can sometimes do harm by concentrating troubled youth together and forcing them to accept a stigmatized identity as an addict before they even know who they really are? (This article focuses only on public non-boarding recovery schools: Some private boarding schools that sell themselves as recovery schools have been cited by former students for using tactics that are known to be abusive and harmful.)

While there is no controlled data so far on the outcome of public recovery schools, the early results look promising. Andrew Finch, assistant professor of counseling at Vanderbilt University, says that outcome studies find the reverse of what research on typical teen treatment like 30-day rehabs and intensive-outpatient programs shows: After treatment, about 70 percent of kids who return to their communities relapse within six months to a year; but after attending recovery schools, only about 30 percent relapse. Although this may reflect the fact that the schools admit only students who say they want to kick drugs and therefore might be more motivated than those who don’t attend, it doesn’t suggest that the programs do harm.

“I think the balance of risk vs. reward is weighted toward the reward side,” says Ken Winters, director of the Center for Adolescent Substance Abuse Research at the University of Minnesota, who is also working to evaluate recovery schools. “[Harmful] effects can happen. Every treatment and recovery group has to worry about that and keep on top of it.”

Consequently, many recovery schools seem committed to avoiding the mistakes often made in adolescent treatment—like “one size fits all” 12-step treatment, punitive and humiliating disciplinary practices, insistence on the acceptance of the “alcoholic” or “addict” label, and rapid expulsion for relapse. Some even take a harm reduction approach, refusing to give up on teens who are not ready or able to become abstinent immediately.

“We work with a lot of vulnerable children,” says Michelle Lipinski, principal of the Northshore Recovery High School in Beverly, Massachusetts. “We have a lot of homelessness. We try to find the thing that they will grab onto to keep them from using. For us to mandate that you need to adhere to the 12 steps, expect this many meetings a week, get a sponsor—it just doesn’t work for about half our population. You have to meet the kid where they are.”

Tina’s story reflects how this philosophy can bear fruit. She had suffered from anxiety disorders and depression since childhood. She began treatment for panic attacks in fourth grade. Her father died when she was 13, but she only learned recently that his heart attack was probably caused by cocaine.

Like Tina, around 75 percent of youth who attend recovery high schools also have diagnosable mental illnesses—and a large proportion also have family members with drug problems. Both issues are addressed regularly in counseling and group sessions in the schools. Unlike Tina, however, most students in these schools have previously been through addiction treatment, often multiple times.

Tina was already enrolled at Northshore when she had the relapse that ultimately spurred her recovery. She’d started attending after nearly dropping out of her prior high school because of her drinking and misuse of anti-anxiety medications like Xanax—but she wasn’t immediately able to commit to abstinence. “For the first year of me being here, I tried every two weeks to get sober and just couldn’t do it,” she says.

However, even when she was using, she usually made herself show up. At her former high school, she hadn’t done that because she says “no one cared,” but at Northshore “they gave a shit so I tried to come.”

And so, when she woke up bleeding from numerous cuts after a binge and read a suicide note she didn’t remember writing, she went to school. She was glad to be alive. “It was terrifying that I could do something like that and have no control over it,” she says.

Her injuries turned out to be more bloody than dangerous, but Tina was afraid the cuts might get infected. “I wasn’t going to show my mom because she had no idea I was cutting myself,” she says. When she got to school, her English teacher helped clean her up, as she sobbed and told her what had happened.

Even then, Tina’s abstinence didn’t start immediately. While she didn’t have another severe relapse, she did on several occasions take a few hits off a joint or have a drink. Now, however, she’s nearly two years sober. “I’m starting college in the fall,” she says, adding that it was the whole school and the 12 steps—not any one person—that helped her the most.

During her relapses, however, she also benefited from the school’s harm reduction philosophy. “They’d sit me down and say, ‘Whenever you’re ready, we’re here,’” she says, adding that she thinks it is “so sad” that some schools expel people much more rapidly.

Stacy, who is now 24, also attended Northshore, but her recovery took a different path. Depression runs in her family—and she wound up misusing Ritalin that was prescribed to her when nothing else worked for her chronic fatigue.

When she took too many pills while out on a day pass from McLean Hospital, where she was being treated for depression, she was transferred from the depression unit into one focused on substance problems. From there, she went on to residential treatment—and then Northshore.

Kristen Johnston promoting SLAM.

Stacy did not find the 12 steps especially useful, although she did go to meetings in treatment and have a sponsor. “I never officially went through the 12 steps,” she says. “It’s not forced on people. It works great for some people, but I definitely think it’s dangerous when you try to put all these different people in one box and say this is the only way you can get better.”

Stacy also says that she didn’t want her entire identity to be focused on recovery. “I got sober at 17,” she says. “If I wasn’t sober, I wouldn’t be all the things that I am, so I think that’s the foundation, but there’s more to life than this.” After graduating from American University, she’s joined the Peace Corps, which had been a dream for her since childhood.

For his part, Liam is attending William J. Ostiguy High School in downtown Boston, where about 40 percent of the school’s roughly 80 students suffer from opioid addictions like he does. Principal Roger Oser says, “We’re abstinence-based, not harm reduction,” and unlike at Northshore, the in-school programming at Ostiguy does include required 12-step components. But even here, alternatives like SMART Recovery can be used instead of attending outside 12-step meetings and relapse does not automatically lead to expulsion. Some students take medications like Suboxone, but because of their age, the plan is for detox, not maintenance.

Since the feeling of being in a safe community is critical to the success of these schools, bullying and violence threaten the entire project. As a result, disciplinary measures tend to focus on restorative justice—making amends to the community—rather than punishment.

“There’s no boilerplate [recovery path] that the student has to follow,” says Oser, adding that, “in early recovery, relapse is often part of the experience.”

Liam, who is a senior, has been drug-free since September and is still also attending the treatment center that referred him to the school. Growing up in a family dominated by addiction, he was hooked on heroin by 17. His opioid use started with prescription pain medication—but he never got it from doctors. “I knew people who sold drugs,” he says, describing how he supported his habit by stealing and dealing.

While his parents’ addictions initially helped enable his own, when they watched him go from an academic success and “good kid” to a thief and dealer, they knew they, too, had to change. Both successfully detoxed last August and now father and son sometimes speak together at 12-step meetings. Ostiguy, he says, “is giving me a life that I never had. I went from literally having nothing to having my whole life in eight months.”

All of the students I spoke with emphasized the sense of community, even family, they felt in their recovery school. Each described behavior that is highly uncharacteristic in many high schools: being able to go to teachers with emotional problems and feeling safe enough to share pain with peers in groups at school.

The schools also recognize that teen drama and heartbreak is part of growing up—so they don’t make unrealistic rules like banning relationships. But all of them are also small enough—typically less than 100 students, often only 30 or 40 or fewer—to provide highly individualized attention to each student. Because students feel so free to share with teachers and even principals, when a break-up, relapse or other emotional event is going on, it’s typically not long before the adults are aware of it and can offer help if needed.

While relapse is recognized as a common issue in recovery, one thing the schools show no tolerance for is bullying. “We have six kids who are openly gay and three transgender kids, and we will not tolerate bullying or abuse,” Lipinski says. (The high proportion of LGBT youth in recovery schools reflects the fact that rates of substance use disorders are two to three times higher in this group, a link associated with stigma related to gender and sexual orientation.)

This inclusive philosophy is echoed by Oser and by Rachelle Gardner, the principal of Hope Academy, a recovery school in Indiana. Since the feeling of being in a safe community is critical to the success of these schools, bullying and violence threaten the entire project. As a result, disciplinary measures tend to focus on restorative justice—making amends to the community—rather than punishment. However, assaulting other students or using drugs on campus tends to result in immediate referral to treatment or expulsion if treatment is rejected.

While drug tests are administered in most recovery schools, a positive result does not necessarily mean return to treatment or expulsion—relapse is not seen as an occasion for punishment, but as a sign that more support is needed. And the more honest the student is about the circumstances of the relapse, the less likely he or she is to be asked to leave the school.

Of course, some parents fear that the stigma associated with addiction might harm these students’ chances of college admission, but so far that hasn’t proven to be a problem. All of the schools, however, see themselves as schools, not treatment—and they do their best to emphasize academic achievement.

“I’m doing this because no one else fucking is,” says the always frank Kristen Johnston of her quest to bring a recovery school to New York. “I partied in high school like a rock star and I was a functional addict for many years, but the bottom line is that those were years of sorrow, misery, and hell. I would really love to be able to give kids the ability to have the good part of that life, not the bad part.”

*Some names have been changed.

This post originally appeared on Substance, a Pacific Standard partner site, as “Recovery High Schools’ Flexibility Is Their Strength.”

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